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An epic battle: Local doctors, pharmacists fighting opioid epidemic

Opioids like Oxycodone and Acetaminophen are dispensed at the Perham Health Pharmacy by Director of Pharmacy Duane Wallace and his staff. Brian Hansel/FOCUS1 / 4

Hydrocodone Pills and Prescription Bottles Under Spot Light.2 / 4

Wallace3 / 4

Paulson4 / 4

The statistics are alarming.

According to the Minnesota Department of Health, deaths from prescription opioids increased 631 percent across the state between the years 2000 and 2016. The death toll from opioids, heroin and psychostimulants, including meth, increased 1,155 percent.

Despite the daunting challenge, Perham Health and Sanford Health are attempting to find ways to deal with the opioid problem.

A Pharmacist's View

"As everyone knows, there is an opioid epidemic going on," Perham Health Director of Pharmacy Duane Wallace said. "We kind of take a look at it from three areas — there is misuse, abuse and then overdose. We decided that we would try and take a look at protocols to see if we could reduce the ordering and the dispensing of opioids and see how that affects the opioids and the deaths that are associated with that."

Wallace said the healthcare institutions are attempting a two-pronged approach.

"We are doing a study where we are decreasing the number of prescriptions written and decreasing the quantity of drugs (opioids) in each one of those prescriptions," Wallace said, adding that he believes they are on "the right track".

Perham Health and Sanford Health started tracking this program in 2014.

"Even though we are still working to reduce this, we still have a long way to go," Wallace said. "What is going on? What are we doing that is not quite working yet?"

As a pharmacist, Wallace is in charge of dispensing and monitoring. His department works closely with the provider, the patient and the prescriptions Perham Health physicians dispense. They want to make sure there is a good diagnosis and the quantity and directions are appropriate.

"If were notice anything that is a little out of the ordinary we will contact them," Wallace said. "We have a very open relationship with them."

In working with the patients what has been discovered is that the dependence on opioids usually takes place when the quantity of medication lasts for more than a period of 45-90 days.

Opioid tracking is also possible through the Prescription Monitoring Program of Minnesota.

"I can look up a patient and find out every time they've got an opioid (prescription) filled anywhere in Minnesota or North Dakota," Wallace said. "In that way, we can make sure they are not getting overfilled."

Wallace also monitors for early refills.

"That's a tell-tale sign that they are misusing their medication or abusing it," Wallace said.

A Physician's View

Dr. Mark Paulson is in family practice at Perham Health and sees the work he is doing with opioids as a "practice change."

It is doctors like Paulson who put the ball in play by prescribing opioids or narcotics to their patients. They share the responsibility with pharmacists in making sure it gets into the right hands in the proper amounts.

There is evidence to suggest that the introduction of synthetic drugs triggered the rise in opioid use in the United States. In the beginning, the manufacturers of these drugs made claims about their safety, which were true, to a certain point.

"They went back and quoted an antidotal statement that somebody said that if we put people on narcotics in the hospital they won't get addicted in the hospital," Paulson said. "Well, nobody gets addicted in the hospital because they are only there for four days. They extrapolated that to say then that they won't ever get addicted to these medications. It was really twisting science and creating its own truth."

But the beginning of the opioid epidemic is not where Paulson is spending his energies. Like many of his fellow medical practitioners, he is doing his best to deal with it now.

"It's just been an exponential rise in the number of people who are dying from narcotics overdoses," Paulson said. "It was something like 70,000 deaths from narcotics this last year in the United States. Back in 1980, it was as low as 10 or 20,000, maybe less than that."

Sanford Health created the Controlled Substance Stewardship Committee in March 2016. Their mandate was to try and bring down the number of narcotic prescriptions that are being made.

The illegal drug market is not the responsibility of physicians but the medical fraternity does bear a burden.

"We are responsible for every pill that enters that realm," Paulson said.

This is one of the portals into a very dark and dangerous world...a world where profits can outweigh morality.

"Some patients will divert (opioids), some (opioids) will be stolen; children, grandchildren, friends will steal them out of cabinets," Paulson said.

Paulson recounted a case in the Perham area where a young woman feigned car trouble, gained entrance to the house by asking to use the phone, then asked to use the bathroom and took all the narcotics out of the bathroom cabinets and leaving.

"There is a significant street value to these medications," Paulson said.

Addiction is a driving force behind the use of opioids. Physicians will prescribe them to treat pain, but addicts will use them to get high. Genetics can dictate how a person reacts to medications. One person can take an opioid and get high. The next person can take an opioid and get nothing.

At a recent medical retreat Paulson learned that for every person who is on pain medication and has not been on it before, the probability of that individual being on a narcotic in one year is one-in-18.

"Our responsibility is to keep as few of those drugs in circulation as possible," Paulson said. "When you look at death rates from heroin and death rates from your standard drugs, those are actually pretty flat. It's the rise in prescription medications — overuse and overdose of prescriptions."

One of the biggest culprits in deaths brought about by overdose is Fentanyl, which has a derivative that is even more potent, according to Paulson.

"The problem is the Fentanyl is about 100 times more potent than any other narcotic," Paulson said.

By not understanding the potency of Fentanyl, a patient can overdose.

"It's a mistake, it's a lack of knowledge," Paulson said.

Paulson pointed out that patients who received opioids to treat a condition may not use their entire supply.

"There are meds in circulation that never get used by people," Paulson said.

One weapon in the arsenal of physicians is a "pain treatment agreement" which basically gives them some control in case they suspect an individual is diverting, overusing or not following the rules. If this is the case, the physician has the right to "terminate" their relationship with the patient. Yet what they are actually doing is stopping their prescription of narcotics with them.

Can total victory ever be won in the battle Wallace and Paulson are fighting?

"This is one of these things that is a battle that I don't know we will ever totally win," Paulson said. 'It's addiction in general. There will also be people who are addicted. "It isn't necessarily that we can win it, but we control it to the best of our ability."